Improving multidisciplinary care in the treatment of muscle-invasive bladder cancer: A quality improvement initiative.

Abstract

e23315 Background: The rapidly evolving treatment landscape for bladder cancer has introduced several new therapy classes, including immunotherapies, antibody-drug conjugates, and kinase inhibitors. Integrating these therapies into routine clinical practice requires coordinated multidisciplinary decision-making including through regular tumor boards; however, real-world implementation remains variable. To address these gaps, PRIME implemented a data-driven quality improvement (QI) initiative aimed at optimizing patient care and enhancing multidisciplinary collaboration. Methods: Between July – October 2025, healthcare professionals (HCPs) who treat bladder cancer (n = 60; 82% physician, 3% NP/PA, 7% nurse, 8% pharmacist) from US academic and community oncology centers were surveyed to evaluate current practices and gaps in multidisciplinary treatment decision making and care in muscle invasive bladder cancer (MIBC). HCPs (n = 81) from participating sites then engaged in audit-feedback (AF) sessions to assess site-specific gaps identified in surveys and develop action plans for improvement. Results: Providers reported several key barriers to multidisciplinary care in MIBC, including lack of or infrequent multidisciplinary tumor boards (61%), inconsistent referrals from other specialists (51%), and coordination and communication challenges (methods, frequency or differing philosophies) (31%) . Although 85% of HCPs reported at least monthly participation in multidisciplinary tumor boards (MTBs) and 98% reported that MTBs included medical oncology, less than 70% reported inclusion of urology, pathology or radiation oncology, and less than 50% reported surgery or radiology participating. Additionally, while 78% of HCPs surveyed reported they were likely or extremely likely (4/5 on 5-point Likert scale) to recommend systemic treatment and 77% to recommend cystectomy for a patient with MIBC prior to discussing the case at an MTB, multidisciplinary case review was not uniformly embedded into clinical workflows, with only 24% of HCPs reporting that every MIBC case is discussed , 13% reporting only complex cases are discussed, and 3% reporting no MIBC patients are ever discussed in an MTB. To mitigate these barriers, HCPs reported that standardized referral workflows (63%), dedicated care coordinators or navigators (53%), and improved communication tools/platforms (37%) would most improve multidisciplinary collaboration and treatment planning in MIBC. Finally, HCP teams developed action plans in AF sessions to increase usage of electronic health record templates, increase MTB utilization for coordination of care, and document progress in implementing multidisciplinary care. Conclusions: Findings from this QI initiative suggest key opportunities to improve implementation of MTBs in patient testing and evaluation for patients with bladder cancer.